Abstract
The aim of the present study was to perform a stereological and biochemical analysis of the foreskin of smoker subjects. Foreskin samples were obtained from 20 young adults (mean = 27.2 years old) submitted to circumcision. Of the patients analyzed, one group (n = 10) had previous history of chronic smoking (a half pack to 3 packs per day for 3 to 13 years (mean = 5.8 ± 3.2). The control group included 10 nonsmoking patients. Masson 's trichrome stain was used to quantify the foreskin vascular density. Weigert's resorcin-fucsin stain was used to assess the elastic system fibers and Picrosirius red stain was applied to study the collagen. Stereological analysis was performed using the Image J software to determine the volumetric densities. For biochemical analysis, the total collagen was determined as µg of hydroxyproline per mg of dry tissue. Means were compared using the unpaired t-test (p < 0.05). Elastic system fibers of smokers was 42.5 % higher than in the control group (p = 0.002). In contrast, smooth muscle fibers (p = 0.42) and vascular density (p = 0.16) did not show any significant variation. Qualitative analysis using Picrosirius red stain with polarized light evidenced the presence of type I and III collagen in the foreskin tissue, without significant difference between the groups. Total collagen concentration also did not differ significantly between smokers and non-smokers (73.1 µg/mg ± 8.0 vs. 69.2 µg/mg ± 5.9, respectively, p = 0.23). The foreskin tissue of smoking patients had a significant increase of elastic system fibers. Elastic fibers play an important role in this tissue's turnover and this high concentration in smokers possibly causes high extensibility of the foreskin. The structural alterations in smokers' foreskins could possibly explain the poor results in smoking patients submitted to foreskin fasciocutaneous flaps in urethral reconstruction surgery.
Highlights
Male urethral reconstruction is one of the oldest problems in reconstructive surgery and has always been a great challenge to urologists [1]
The foreskin tissue was analyzed in two different regions, the ventral area and dorsal area
The elastic system fibers in the foreskin of smokers was 42.5% higher than in the control group (32.0 ± 6.3 vs. 45.6 ± 10.1, respectively; p = 0.002) (Figure-2)
Summary
Male urethral reconstruction is one of the oldest problems in reconstructive surgery and has always been a great challenge to urologists [1]. Urethral stricture is a fibrotic process resulting in a scar tissue with low compliance, decreasing the caliber of the urethral lumen. Depending on the degree of stenosis, urethral stricture has variable impact on the patients micturition [2]. The surgical techniques described to correct urethral stenosis in the past decade have allowed remarkable advances in the treatment of this condition. Anastomotic urethroplasty with excision of scar tissue is associated with better long term results [5]. When this procedure is impossible due to the large extension of the lesion, tissue transfer techniques can be chosen, like fasciocutaneous flaps or grafts (oral mucosa or genital skin) [6]
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